Dermatologic Surgery Complications

  • Amylynne J. Frankel
  • Ellen S. Marmur


Dermatologic surgery is often performed in an outpatient surgical suite with local anesthesia, and moderate to advanced dermatologic procedures may be done without monitoring vital signs. A sound knowledge of the common dermatologic surgery complications is essential to a safe surgical practice. For example, identifying at-risk patients is key to preventing avoidable complications. Complications are to be expected in high volume practices. However, complications should be approached with well-rounded knowledge and managed accordingly. This chapter presents several of the most common surgical considerations for safe surgery and prevention and management of emergencies in dermatologic surgery.


Wound Dehiscence Excessive Bleeding Wound Edge Filler Injection Chemical Peel 
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  1. 1.
    Hurst EA, Yu SS, Grekin RC, Neuhaus IM. Bleeding complications in dermatologic surgery. MD Semin Cutan Med Surg. 2007;26:40–6.Google Scholar
  2. 2.
    Bunick CG, Aasi SZ. Hemorrhagic complications in dermatologic surgery. Dermatol Ther. 2011;24:537–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Dinehart SM, Henry L. Dietary supplements: altered coagulation and effects on bruising. Dermatol Surg. 2005;31:819–26.PubMedCrossRefGoogle Scholar
  4. 4.
    Billingsley EM, Maloney ME. Intraoperative and postoperative bleeding problems in patients taking warfarin, aspirin, and nonsteroidal anti-inflammatory agents. Dermatol Surg. 1997;23:381–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg. 2004;30:1091–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Alcalay J. Cutaneous surgery in patients receiving warfarin therapy. Dermatol Surg. 2001;27:756–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Otley CC, Fewkes JL, Frank W, et al. Complications of cutaneous surgery in patients who are taking warfarin, aspirin, or nonsteroidal anti-inflammatory drugs. Arch Dermatol. 1996;132:161–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Lam J, Lim J, Clark J, et al. Warfarin and cutaneous surgery: a preliminary prospective study. Br J Plast Surg. 2001;52:372–3.CrossRefGoogle Scholar
  9. 9.
    Bartlett GR. Does aspirin affect the outcome of minor cutaneous surgery? Br J Plast Surg. 1999;52:214–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Kovich O, Oltey CC. Thrombotic complications related to discontinuation of warfarin and aspirin therapy perioperatively for cutaneous operation. J Am Acad Dermatol. 2003;48:233–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Alam M, Goldberg LH. Serious adverse vascular events associated with perioperative interruption of antiplatelet and anticoagulant therapy. Dermatol Surg. 2002;28:992–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Schanbacher CF, Bennett RG. Postoperative stroke after stopping warfarin for cutaneous surgery. Dermatol Surg. 2000;26:785–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Kovich O, Otley CC. Perioperative management of anticoagulants and platelet inhibitors for cutaneous surgery: a survey of current practice. Dermatol Surg. 2002;28:513–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Kirkorian AY, Moore BL, Siskind J, Marmur ES. Perioperative management of anticoagulant therapy during cutaneous surgery: 2005 survey of Mohs surgeons. Dermatol Surg. 2007;33(10):1189–97.PubMedCrossRefGoogle Scholar
  15. 15.
    Bordeaux JS, Martires KJ, Goldberg D, Pattee SF, Fu P, Maloney ME. Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications. J Am Acad Dermatol. 2011;65(3):576–83. Epub 2011 Jul 22.PubMedCrossRefGoogle Scholar
  16. 16.
    Saleh K, Sonesson A, Persson B, Riesbeck K, Schmidtchen A. A descriptive study of bacterial load of full-thickness surgical wounds in dermatologic surgery. Dermatol Surg. 2011;37(7):1014–22. doi: 10.1111/j.1524-4725.2011.02040.x. Epub 2011 May 25.PubMedCrossRefGoogle Scholar
  17. 17.
    Martin JE, Speyer LA, Schmults CD. Heightened infection-control practices are associated with significantly lower infection rates in office-based Mohs surgery. Dermatol Surg. 2010;36(10):1529–36.PubMedCrossRefGoogle Scholar
  18. 18.
    Hurst EA, Grekin RC, Yu SS, Neuhaus IM. Infectious complications and antibiotic use in dermatologic surgery. Semin Cutan Med Surg. 2007;26(1):47–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Hirschmann JV. Antimicrobial prophylaxis in dermatologic surgery. Cutis. 2007;79(6 Suppl):43–51.PubMedGoogle Scholar
  20. 20.
    Shurman DL, Benedetto AV. Antimicrobials in dermatologic surgery: facts and controversies. Clin Dermatol. 2010;28(5):505–10.PubMedCrossRefGoogle Scholar
  21. 21.
  22. 22.
    [Guideline] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116(15):1736–54.Google Scholar
  23. 23.
    Saleh K, Sonesson A, Persson B, Riesbeck K, Schmidtchen A. A descriptive study of bacterial load of full-thickness surgical wounds in dermatologic surgery. Dermatol Surg. 2011;37(7):1014–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Wood L, Warner N, Billingsley E. Infectious complications of dermatologic procedures. Dermatol Ther. 2011;24:558–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59(3):464–73.PubMedCrossRefGoogle Scholar
  26. 26.
    Cordova KB, Grenier N, Chang KH, Dufresne Jr R. Preoperative methicillin-resistant Staphylococcus aureus screening in Mohs surgery appears to decrease postoperative infections. Dermatol Surg. 2010;36(10):1537–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Delaney A, Diamantis S, Marks V. Complications of tissue ischemia in dermatologic surgery. Dermatol Ther. 2011;24:551–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Lawrence WT, Murphy RC, Robson MC, Heggers JP. The detrimental effect of cigarette smoking on flap survival: an experimental study in the rat. Br J Plast Surg. 1984;37(2):216–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Khachemoune A, Kreici-Papa N, Finn DT, Rogers GS. Dehisced clean wound: resuture it or steri-strip it? Dermatol Surg. 2004;30(3):431–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Zhang AY, Obagi S. Diagnosis and management of skin resurfacing—related complications. Oral Maxillofacial Surg Clin N Am. 2009;21:1–12.CrossRefGoogle Scholar
  31. 31.
    Alam M, Warycha M. Complications of lasers and light treatments. Dermatol Ther. 2011;24:571–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Batra RS, Jacob CI, Hobbs L, Arndt KA, Dover JS. A prospective survey of patient experiences after laser skin resurfacting: results from 2 ½ years of follow-up. Arch Dermatol. 2003;139:1295–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Cohen JL. Understanding, avoiding, and managing dermal filler complications. Dermatol Surg. 2008;34 Suppl 1:S9209.Google Scholar
  34. 34.
    Grunebaum LD, Allemann IB, Dayan S, et al. The risk of alar necrosis associated with dermal filler injection. Dermatol Surg. 2009;35:1635–40.PubMedCrossRefGoogle Scholar
  35. 35.
    Winslow C. The management of dermal filler complications. Facial Plast Surg. 2009;25(2):124–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Bolognia J, Jorizzo J, Rapini R (eds) Dermatology, 2nd ed. Mosby, 2007.Google Scholar
  37. 37.
    Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention and treatment of dermal filler complications. Aesthetic Surg J. 2011;31:110–21.CrossRefGoogle Scholar
  38. 38.
    Cohen JL. Understanding, avoiding and managing dermal filler complications. Dermatol Surg. 2008;34:s92–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Cohen JL, Brown MR. Anatomic considerations for soft tissue augmentation of the face. J Drugs Dermatol. 2009;8:13–6.PubMedGoogle Scholar
  40. 40.
    Glaich D, Cohen J, Goldberg L. Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers. Dermatol Surg. 2006;32:276–81.PubMedCrossRefGoogle Scholar
  41. 41.
    Grunebaum LD, Elsaie ML, Kaufman JY. Six-month, double-blind, randomized, split-face study to compare the efficacy and safety of calcium hydroxylapatite (CaHA) mixed with lidocaine and CaHA alone for correction of nasolabial fold wrinkles. Dermatol Surg. 2008;36:760–5.CrossRefGoogle Scholar
  42. 42.
    Sclafani A, Fagien S. Treatment of injectable soft ­tissue filler complications. Dermatol Surg. 2009;35:1672–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Nichter LS, Morwood DT, Williams GS, Spence RJ. Expanding the limits of composite grafting: a case report of successful nose replantation assisted by hyperbaric oxygen. Plast Reconstr Surg. 1991;87:337–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Rapley JH, Lawrence WT, Witt PD. Composite grafting and hyperbaric oxygen therapy in pediatric nasal tip reconstruction after avulsive dog bite injury. Am Plast Surg. 2001;46:434–8.CrossRefGoogle Scholar
  45. 45.
    Sanchz S, Schippert W, Ulmer A, et al. Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol. 2002;146:928–9.CrossRefGoogle Scholar
  46. 46.
    Niamtu J. Complications in fillers and botox. Oral Maxillofacial Surg Clin N Am. 2009;21:13–21.CrossRefGoogle Scholar
  47. 47.
    Khunger N, IADVL Task Force. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol. 2008;74(Suppl):S5–12.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  1. 1.Department of DermatologyMt. Sinai School of MedicineNew YorkUSA
  2. 2.Mount Sinai Medical CenterNew YorkUSA
  3. 3.Department of DermatologyThe Mount Sinai Medical CenterNew YorkUSA
  4. 4.Department of Genetics and Genomic ResearchThe Mount Sinai Medical CenterNew YorkUSA
  5. 5.Cosmetic & Surgical DermatologyThe Mount Sinai Medical CenterNew YorkUSA
  6. 6.Procedural DermatologyThe Mount Sinai Medical CenterNew YorkUSA
  7. 7.Cosmetic DermatologyThe Mount Sinai Medical CenterNew YorkUSA

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